Patellar tendonitis, or more properly called patellar tendinopathy, and also called quadriceps tendonopathy or tendonitis, is the term for micro-tearing or degeneration of the patellar tendon, which is just below the knee cap.
Is this the same condition as "jumper's knee?"
The condition has been named “jumper’s knee” since excessive loading of the knee during high frequency repetitive jumping is considered the primary risk factor. The condition may more aptly named “landing knee” because research has shown forces placed on the tendon during landing are approximately double those created during the lift off phase (2,3,4). Activities that involve rapid acceleration and deceleration are also thought to place the patellar tendon at risk (5).
How common is patellar tendonitis?
Patellar tendinopathy is common, affecting up to 20% of athletes with a prevalence as high as 50% in sports which require repetitive forceful jumping and landing like volleyball and basketball (6,7). Interestingly, when the condition is present only on one side, it affects males more commonly at a ratio of 2:1. When the problem presents on both sides, both sexes are equally affected (6). Athletes who land with excessive foot inversion or allow deeper angles of knee flexion have a higher risk of developing the condition (7,8,9).
What are the symptoms of patellar tendonitis?
Symptoms are often chronic without an identifiable onset, sometimes relapsing or remitting over months or years. Symptoms are provoked by activity, but most athletes have been able to continue playing through the pain. Patients will report that pain intensifies when rising from a seated position, squatting, jumping, stair climbing or running- especially downhill or downstairs (10).
Two-thirds of patients present with pain in the characteristic inferior patellar location.
Do patellar tendonitis patients have tight or weak quadriceps?
Patients with patellar tendinopathy often demonstrate quadriceps and hamstring tightness with associated myofascial involvement. Additionally, quadriceps weakness is common in patellar tendonitis patients. Compensatory mechanisms to protect the knee may result in secondary problems throughout the lower kinetic chain.
Are x-rays or imaging necessary?
Imaging may be unnecessary unless a history of trauma, surgery, or joint swelling in older individuals. MRI to diagnose patellar tendinopathy is questionable (14, 15).
What is the best treatment for patellar tendonitis?
The foundation for clinical management of patellar tendonitis includes anti-inflammatory modalities, transverse friction massage, and eccentric exercise. Modalities including ultrasound, interferential, and ice may help diminish inflammation.
Some athletes may need to decrease training amount and intensity to reduce the load to a sub-pain threshold level.
Stretching and myofascial release techniques should be directed at areas of concern in the hamstring, quadriceps, and calves. Additional areas of myofascial concern would include the iliotibial band, psoas, piriformis and anterior hip capsule. Transverse friction massage or IASTM is thought to improve clinical outcomes by stimulating a healing response (18).
Manipulation may be necessary for restrictions in the ankle, knee, hip or lumbosacral region.
Do I need to rest with patellar tendonitis?
Patellar tendonitis patients should avoid complete rest, as this could actually increase the risk of recurrence (17). Ice or ice massage should be used at home and after activity.
What does rehab look like for patellar tendonitis?
Rehabilitation of patellar tendonitis typically progresses from selective rest to functional re-training. The goal of tendinopathy rehab is to carefully balance a controlled inflammatory response without causing greater injury or exacerbating symptoms. Rehab should begin with moderate effort and low repetitions. Response to rehab may be assessed by the patient’s change in night pain. Increases in night pain indicate the current rehab load is excessive. Progression advances when the patient tolerates a given level of load. (29)
Eccentric exercise along with static stretching is a vastly superior mode of treatment for patellar tendonitis (19,20,21).
What about a patellar tendon strap?
Patellar tendon straps, like a DonJoy Cross Strap, ProTec or Cho-Pat, are thought to slightly reorient the patellar tendon, thereby reducing stress on the most vulnerable fibers (27). The majority of people utilizing patellar tendon straps report improvement (23)
What about other treatments?
In general, patients undergoing surgery for patellar tendinopathy show similar outcomes to those undergoing eccentric strengthening program (24). Stubborn cases may consider PRP or steroid injections.
At Creekside Chiropractic & Performance Center, we are highly trained to treat patellar tendonitis. We are the only inter-disciplinary clinic providing services to Sheboygan, Sheboygan Falls, Plymouth, and Oostburg including chiropractic, manual therapy, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
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